FLEXIBLE FITNESS: Managing tendon troubles in the hand

Michelle Cormier / Daily News Correspondent

Tuesday

Dec 18, 2018 at 1:53 PMDec 18, 2018 at 9:17 PM

When a person uses their hands in repetitive ways, either at work or during leisure activities, several injuries can occur. Two of the most common injuries include Trigger Finger and DeQuervain’s Tenosynovitis. Both injuries have some similarities in that they are more common in women than men, often occur between the ages of 30 and 50 and are caused by prolonged gripping or repetitive use of the hands.

Trigger finger is one of the most common causes of hand pain and disability. Trigger finger occurs when a tendon in your hand snaps as you bend and straighten your fingers. Normally a tendon, which is surrounded by a tendon sheath, glides easily through the sheath. When the tendon becomes inflamed, scarring and thickening can occur which impedes tendon motion. A nodule can also develop on the tendon. Imagine trying to thread a piece of string through the eye of a needle that has a knot in it. You can thread the needle, but it catches as you pull the knot through. This is similar to what occurs with trigger finger. When you make a fist, the tendon moves towards your wrist and then when you go to straighten the finger the nodule catches under the sheath and you feel a snap. It can affect all fingers and the thumb, but the ring finger is the most common.

Trigger finger can be caused by repetitive motion of your fingers or by forceful gripping or grasping of an object for long periods of time. Individuals whose occupations include the use of tools may be more susceptible to this problem. Rheumatoid arthritis and diabetes can also cause trigger finger.

Symptoms often start with soreness at the base of the finger. There can be popping or snapping of the tendon when you bend or straighten your finger. When trigger finger becomes severe, the tendon can get stuck when you make a fist. If this happens you cannot straighten your finger without the help of the other hand and it is often quite painful.

Treatment for this condition includes resting the affected finger with a fabricated custom splint that prevents the finger from bending. The splint is usually worn at night and is custom made by an accupational therapist (OT) or certified hand therapist (CHT). Ice and anti-inflammatory medications can also help to decrease the pain and inflammation associated with trigger finger. If the above interventions do not work, your physician may consider injecting the tendon with a steroid which is one of the most effective treatments. Surgery may be required if the symptoms continue despite conservative treatment. Following surgery, occupational therapy may be recommended for swelling, scar management and exercises.

DeQuervain’s Tenosynovitis is a tendonitis which is an inflammation of the tendons. There are two tendons on the thumb side of your wrist that are responsible for pulling your thumb up in an extended position and pulling it out away from your index finger for example when you grab a glass. When there is thickening of the tendons from a sudden or repetitive injury, it affects the gliding of these tendons through the tendon sheath. Movement of the thumb and/or wrist can increase swelling and inflammation which will increase pain. DeQuervain’s Tenosynovitis, like trigger finger, is more common in women than men and usually occurs between the ages of 30 and 50 but it doesn’t occur as often as trigger finger. Causes of DeQuervain’s Tenosynovitis include repetitive use of the thumb or from direct injury to the thumb. Pregnant women and women with young children are often at increased risk.

Symptoms include pain on the thumb side of the hand especially with a forceful grip and pinch with twisting of the hand. Pain can also occur with a hammering motion of your wrist with your thumb in a fist. The pain can radiate up into the forearm. Pinching and gripping objects can be difficult. Pain can increase with activity and there can also be swelling on the thumb side of your wrist.

Conservative treatment includes splinting both the thumb and wrist which allows the tendons involved to rest, icing, anti-inflammatory medication and activity modification such as avoiding activities that produce pain. If pain does not improve with treatment, surgery may be warranted.

Occupational therapy may be helpful both before and after surgery for splinting, exercises, scar management and progression to strengthening.

If you experience any of these symptoms, speak to your primary care physician to see if a referral to an occupational therapist would be helpful. The Occupational Therapist can determine if you would benefit from a customize splint. They can also address what activities might be contributing to your pain and how to modify them.

Michelle Cormier, CHT, OTR/L is an occupational therapist and a certified hand therapist at Spaulding Rehabilitation Outpatient Center Framingham. Her interests include treating all diagnoses of the hands from post-op injuries to chronic repetitive diseases.